Chest
Volume 91, Issue 6, June 1987, Pages 829-832
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Clinical Investigations
Whole-Lung Lavage Under Hyperbaric Oxygen Conditions for Alveolar Proteinosis with Respiratory Failure

https://doi.org/10.1378/chest.91.6.829Get rights and content

Whole-lung lavage under hyperbaric oxygen conditions was performed in two patients suffering from severe respiratory insufficiency in pulmonary alveolar proteinosis. Under these conditions, gas exchange was maintained and the mixed venous partial pressure of oxygen and oxygen saturation showed increases to acceptable levels. This enabled us to limit the FIo2 in order to extend the oxygen tolerance and to perform lavage procedures more effectively. Both patients showed a very significant improvement of their clinical course, and we conclude that elective use of hyperbaric oxygen in unilateral lung lavages should be considered in these severe cases.

Section snippets

Bronchopulmonary Lavage Under Hyperbaric Oxygen Conditions

Unilateral whole-lung lavage was performed under hyperbaric oxygen conditions at 2 ATA (atmosphere absolute), in a large multiplace hyper-pressure walk-in chamber. Patients were pretreated with hydrocortisone (250 mg slow IV), starting 12 hours before the procedure. Each patient was lavaged first in the left lung (LLL) with, in total, 20 L of normal saline solution at 37°C. The right lung supported as much gas exchange as possible.

After two to three weeks’ recovery time, right lung lavage (RLL)

CASE 1

A 29-year-old man was referred to another hospital with progressive severe shortness of breath. A six-week trial of high-dose corticosteroid therapy was unsuccessful and a subsequent left-sided open-lung biopsy showed pulmonary alveolar proteinosis. The patient was then referred to us for further evaluation. He smoked up to 40 cigarettes a day for more than ten years. He worked as a roadmaker and lived in a rural area. Physical examination revealed a persistent unproductive cough, peripheral

DISCUSSION

Whole-lung lavage is a commonly used procedure in the treatment of pulmonary alveolar proteinosis3, 12 and is generally indicated when the arterial oxygen tension is less than 60 mm Hg (at rest) or when hypoxemia limits exercise.13 Conventional lavage is unsuitable, however, if highly afflicted patients are unable to maintain satisfactory gas exchange in the nonlavaged lung during the lavage procedure, and literature studies indicate a direct negative correlation between low initial PaO2 (and

REFERENCES (15)

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Manuscript received July 30; revision accepted December 2.

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